General Session: Developing Pharmacologic Guidelines for the Management of Rheumatic Diseases

Jill Wong, MD, Andrew Thompson, MD

The objective of this session was to define the processes involved in developing and implementing guidelines for medication management of rheumatic diseases. It is recognized that pharmacy is the most widely used healthcare benefit. The challenge faced is rising pharmacy costs, due to new drugs, increased wholesale costs and an aging population.

The goals for guideline development include:

1.	Establish care and outcome guidelines to direct resource utilization
2.	Evaluate care activities by health plan's providers
3.	Develop a provider profiling and reporting system.

The guidelines should be evidence based, data driven, and outcome directed. The first phase of guideline development is identifying the current practice and state-of-the-art practice through literature review. These two are then compared, to determine if a gap exists. If a gap does exist, a preferred practice guideline is created. The second phase of guideline development consists of dissemination, education and communication of the preferred practice guideline. The third phase involves monitoring current performance of the guideline and providing feedback to providers. The fourth and final phase is recognizing practice excellence and designating preferred provider status.

In this model, every physician and other healthcare provider is an accountable provider. The alternatives to healthcare professionals taking the lead in developing guidelines to control costs are government control, or external economic forces placing limits on spending, benefits and use of new technologies.

The development of guidelines provides perspective on how to manage the majority of patients. It gives healthcare providers control over resource utilization, resulting in a higher level of acceptance by the providers.

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This program has been provided through an unrestricted educational grant from McNeil Consumer Healthcare, the makers of TYLENOL*(acetaminophen).

*trademark